Benefits of NDNQI: What is in it for You?


“Nurses have to be full partners with physicians and other health
care providers in redesigning the health care system,”
- former Secretary of the US Department of Health and Human Services, Donna E. Shalala
(Kuehn, 2010, p. 2345)

Institute of Medicine (IOM) and Robert Wood Johnson Foundation

  • In October of 2010, a report was released, “The Future of Nursing: Leading Change, Advancing Health,” and it is shaking up healthcare as we know it. 
  • The American Medical Association (AMA) is not happy with the outcome of the report.
  • Nurses are featured and acknowledged, by the IOM, as the leaders and agents who will transform the health care system
  • Nurses ensure care is patient centered, effective, safe, and affordable
  • Nursing community to embrace this report as a blueprint for action
  • Nurses use evidence-based research and collaboration to improve health care
  • Nurses have the proven solutions, but they cannot do it alone
(Carlson, 2010)

IOM: Eight Recommendations

  • Remove scope-of-practice barriers.
  • Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
  • Implement nurse residency programs.
  •  Increase the proportion of nurses with baccalaureate degrees to 80% by 2020.
  • Double the number of nurses with a doctorate by 2020.
  • Ensure nurses engage in lifelong learning.
  • Prepare and enable nurses to lead change to advance health.
  • Build an infrastructure for the collection and analysis of inter-professional health care workforce data.
(Nickitas, 2010, p.385)

IOM: Four Messages

  • Nurses should practice to the full extent of their education and training.
  • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  • Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
  • Effective workforce planning and policymaking require better data collection and an improved information infrastructure.
                                                                                        = NDNQI
The NDNQI is one way to document what we as nurses do.  It is also a way to document what effect changes in staffing have on patient care.
(Nickitas, 2010, p.385)

NDNQI Nursing Workforce Characteristics

  • Total nursing hours per patient day
  • RN hours per patient day
  • Percent of total nursing hours supplied by RNs, LPNs/LVNs, and unlicensed assistive nursing personnel
  • Percent of nursing hours supplied by contract or agency staff
  • Nurse turnover: controllable/uncontrollable (adapted from National Quality Forum) or voluntary/involuntary (Magnet)
  • Years of RN experience (survey) in the unit and in nursing
  • RN education
  • RN certification (by a national body)
  • RN job satisfaction
  • RN intention to stay in the unit, in the hospital, and in nursing

Beneficial Uses for NDNQI Reports

Picture
  • Quality improvement - Unit-level comparisons of staffing data and patient outcomes with units in like hospitals
  • Satisfy reporting requirements, e.g. for Joint Commission or the Magnet Hospital program
  • RN retention efforts
  • RN recruitment
  • Patient recruitment
  • Nursing administration (budget planning, resource allocation)
  • Staff education (Expanding evidence-based practices.)
  • Research
    (Anderson, Manno, O'Connor, & Gallagher, 2010)

NDNQI and Its Benefits for Staff


Nursing leaders at participating facilities have used the information obtained from the NDNQI to advocate for more staff (Montalvo, 2007).

Nursing Job Satisfaction Research

High RN Job Satisfaction:
  • Higher commitment to the organization
  • Higher intent to stay in the job
  • Lower turnover
  • Lower nurse burnout
  • Lower rates of needlestick injuries to nurses
  • Higher patient satisfaction
  • Lower risk adjusted Medicare mortality
Higher Patient-to-Nurse Ratios:
  • Lower job satisfaction
  • Higher emotional exhaustion
  • Higher patient risk-adjusted mortality
  • Failure to rescue
(Boyle, Miller, Gajewski, Hart, & Dunton, 2006)

Benefit to Research

Picture
Researchers will also continue to benefit from these NDNQI enhancements. These developments will enable researchers to fine-tune their research questions and identify additional associations between nursing workforce characteristics and processes and the observed patient outcomes.